The Anchor Trust is a registered social landlord
and registered charity providing care and housing for older people.
We are the largest not-for-profit organisation working in the
field of housing and social care for older people in England.
Our range of services includes:

2.1 Why people, particularly older people,
remain in acute hospital beds after they have been assessed as
clinically ready to be discharged safely is a complex question.
Yet a vitally important one given the speed with which, whilst
in hospital, older people can lose functional skills and risk
compromising their ability again to live independently, not to
mention the significant risks of acquiring an infection. Anchor
Trust therefore welcomes this inquiry by the Health Select Committee,
as it has welcomed the increasing emphasis on this issue in recent
Government policy statements.

2.2 Of course the simple encapsulation of
the problem in the phrase "delayed discharges" masks
the broad range of factors which contribute to itand which
make its solution so complex. The falling number of residential
and particularly nursing care places, especially in the south
and south east, is an obvious example. But there are wider factors
such as the rising levels of homeownership which often leave older
people "asset rich but income poor", and as a consequence
living in poor conditions to which clinical staff are reluctant
to discharge them.

2.3 The English House Condition Survey 1996
showed that the highest percentage of those living in unfit homes
were older people. This is not just an issue for health. The Department
of Transport, Local Government and the Regions has recently consulted
its response on changing from Housing Fitness Standards to a Health
and Safety Rating System. This will provide for a more holistic
assessment of housing conditions against a range of individual
primary health and safety risks in the home. The outcome of which
will include a health gain by preventing property related accidents
and health risks and thus avoidable admission into hospital or
access to primary health services.

2.4 The recent announcement of additional
Government funding to social services authorities of £300
million over the period to March 2003 to tackle the issue is welcome,
though needs to be seen in the context of overall community care
funding of some £5 billion per annum. At this stage it is
too early to say what impact the renewed emphasis and funding
will have in this area, but we believe that effective partnership
with housing providers, such as Anchor, is integral to a "whole
system" approach to help with the problems of delayed discharge.
It can aid the delivery of intermediate care provision and help
prevent some older people being admitted to more costly forms
of care which are not clinically necessary.

2.5 This paper is not a comprehensive submission,
but is intended to show some current practical examples of good
partnership working with housing providers such as Anchor.

A. EXTRA CARE

Extra Carealso known as very sheltered
housingis a development of traditional sheltered housing
and aims to support frailer tenants (an increasing proportion
of those in sheltered accommodation) to maintain their ability
to live satisfactorily in such schemes. The "extra care"
schemes aim to promote independence by providing an individually
tailored care package provided by a care team which is usually
based on site.

Fairfield Court, Tameside

The block has 14 residents, three of whom moved
from some form of residential or nursing placement. Research has
demonstrated that for eight tenants there has been a substantial
decrease in the care input that they needed, having moved into
the scheme with substantial packages of care. The weekly decrease
in care needs and costs are briefly as follows (fuller details
can be supplied if required):

 7 hours care (£42.00).

 3 hours care and 1 day Day Care (£43.38).

 10 hours care and 5 Meals on Wheels
(£72.35).

 Was in specialist residential placement
for adults with a physical disability (£592.00).

 4.5 hours care (£27.00).

 Was in family placement (£83.50).

 Was in nursing placement (£225.96).

Other evident reveals that tenants experienced
a reduction in stress and improvement in mental health, thus lessening
the risk of relapse and hospital admission. Their views echo this.

"The staff encourage me to do things for
myself, plus the way the kitchen and bathroom are designed helps,
and so do the wide doors. So I need less help than where I lived
before."

" I'm more confident and I know that I
am taking my medication at the right time, in the right quantity
so my health has improved, so I am able to be more independent."

"I feel safer so my mental health has improved
and so I am doing more for myself."

B. HOSPITAL DISCHARGE
SCHEME STAYING
PUT PROJECTS

Staying Put Projects are Home Improvement Agencies.
They help older and disabled homeowners repair, improve and adapt
their properties, allowing them to remain in their own homes.

Hackney Staying Put Hospital Discharge Scheme

The project began in 1994 with funding from
the Department of Health. It is targeted at improving the housing
conditions of older and disabled people who live in LB Hackney
and have been admitted to local hospitals (Homerton, Barts, Whittington).
Hospital doctors, nurses, occupational therapists and social workers
refer clients to the project.

The Hospital Discharge team assesses the client's
housing conditions and where necessary temporary accommodation
is arranged for clients while work is carried out eg in an Anchor
sheltered housing scheme. The client is helped to maximise their
income by claiming benefits such as Attendance Allowance and supported
through the hospital discharge/home improvement process.

Most of the work which is carried out using
improvement grants administered by LB Hackney's Environmental
Health Department, cost in the region of £1,000 per home
and usually qualify for Home Repair Assistance, although there
are some repairs which require more expensive and extensive work
such as major aids and adaptations. The project enables older
people to be discharged from hospital into housing appropriate
to their needs where they can live independently or with the support
of some home care. This is likely to be a more cost-effective
arrangement than moving into residential care or nursing care,
or having a prolonged stay in hospital. It also reduces the chances
of crisis re admissions to hospital due to inappropriate housing
conditions.

A typical example of a person being helped by
the project is Mr L who had been admitted to hospital with pneumonia.
Whist there he reported to the hospital social worker that his
electric water heater had broken down.

The project's Technical Officer visited his
home and arranged for an electrician to repair the water heater
as an interim measure. Mr L was then discharged.

When the Caseworker undertook a detailed assessment,
she found that Mr L had inefficient old cast iron heating system.
This contributed to his bronchitis and epilepsy. He believed that
he would not benefit from a gas central heating system as he and
his wife would not be able to afford to run this. The Caseworker
carried out a benefits check and established that they were entitled
to a large sum of council tax benefit. She assisted them to complete
an application, and arranged for a visiting officer to see them
and verify their claim.

They were also assisted with the process of
obtaining estimates, and applying for the necessary grants to
have a new gas central heating system installed. The work was
funded by a Home Repair Assistance grant, a charitable donation,
and a small contribution from themselves.

Mr L and his wife are now happily living in
a warm house, and Mr L has not suffered any reoccurrence of his
chest pains. They are also able to pay the cost for their fuel
because of the savings they have made on their council tax bill.

C. USING ASSITIVE
TECHNOLOGY

Assistive Technology can be defined as a product
that enables independence and improve the quality of life of individuals
whatever their setting.

St Johns Court, Rotherham has 32 flats. Over
50 per cent of the tenants are aged 76 years or over. 93 per cent
are women.

The block was fitted with class 5-wire data
communication, capable of carrying a multiplicity of data signals.
A PABX control system was also fitted. This is, in effect, a mini
telephone exchange, that handles incoming data. It provides tenants
with telephone extensions (with their own number) and therefore
reduces the number of BT and cable lines into the scheme. It also
allows telephone based community alarm systems rather than the
traditional hardwire alarms. Internal calls (between flats) are
free of charge.

Pendants replaced the traditional pull alarm
cords (although one was left in the bathroom as this maybe used
at night and when the tenant may not be wearing a pendant). The
tenants receives a morning call via their phone. To answer the
tenant presses the pendant to open an open communication line
with the scheme manager/phone line. This can be done without having
to get out of bed. To close the line the tenant simply presses
the pendant again. They will then be able to receive telephone
calls as normal.

A camera was fitted at the front door and linked
through the system to tenants TV sets. By pressing channel 7 they
are able to see who is at the main front door and by pressing
the pendant can grant access.

The flexibility of this system means that it
could be adapted to each individual tenants needs and could be
used to monitor a range of things from inactivity to flood monitoring.
It can also be used to monitor health needs such as blood pressure
and temperature.